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I am looking into just having my own small practice cash only.  It will just be me, no additional employees, and no hassle with insurance companies.  My question is if I have a cash only practice do I still need an EMR system?  

Of course I will have malpractice to cover the business and some form of incorporation (likely LLC).  It is really the EMR that is throwing me.  I get it that I would be charged a % of income annually by Medicare for not using an EMR system, but I don't plan on taking Medicare.  What are your thoughts?

Thank you in advance..

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I am looking into just having my own small practice cash only.  It will just be me, no additional employees, and no hassle with insurance companies.  My question is if I have a cash only practice do I still need an EMR system?  

Of course I will have malpractice to cover the business and some form of incorporation (likely LLC).  It is really the EMR that is throwing me.  I get it that I would be charged a % of income annually by Medicare for not using an EMR system, but I don't plan on taking Medicare.  What are your thoughts?

Thank you in advance..

I worked at a nonprofit that didn't charge for services and we used paper charts. No superbill and no EMR.

 

EMR implementation (along with meaningful use) was a Trojan horse used by non medical admins and government to destroy the very foundation of our profession (trust and relationship between patient and provider) under the guise of "making our jobs easier..." In actuality it was used to quantify our value in the Healthcare system BY THEIR standards thereby polluting our great profession. It is universally hated by providers [emoji23] and I hope it dies a fiery death soon... Whew had to get that off my chest [emoji23]

 

Anyhow best wishes on your new practice.

 

Sent from my SM-G975U using Tapatalk

 

 

 

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EMR's are getting better

I had my own house call practice and was on practice fusion (Was free at the time)

It was okay

 

Benefits - no paper charts - if you price these you might fall over at how expensive the supplies are - seriously a lot of money

easy to access - with a computer I could see in anyone's chart any time - makes a difference when you are starting up and doing everything all yourself

Scripts are easy - non-controlled - poof off they go

integration with the fax machine is nice....  fax machines, phone lines, paper and toner are all expense. 

after closing (my doc moved and due  to dependent status I pretty much gave up finding another one that would not want too much money, or try to micromanage me) I have been able to keep track of all my records with ZERO expense - no disposal fees, no storage fees, any records requests come through and dealt with electronically

 

 

Negatives -

first time loading patients does take more time - don't do shortcuts - get em loaded as it makes a difference in the long run

cost - I had a free one, but then had to pay the billers 5.5% - now it seems the EMR companies  do the billing and collect about that much.  If you are not billing insurance then this might be up for debate with the company - getting a flat rate might be worth while

takes computers and wifi - but yo likely have that already

 

 

 

So overall - I would find a flat rate EMR that can prescribe.  They are slower then paper FOR THE MEDICAL ONLY but the administrative benefits are HUGE and as a new practice you are going to have ZERO extra time - if the EMR does not have a fax server consider getting an online one like UPDOX - again to save time and money in the long run

 

 

 

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I appreciate all your feedback.  I definitely found that EMR's really did not help my patient-provider relationship.  In fact, my job became much harder as soon as I started using them.  Mind you, I am very computer literate so it wasn't the EMR part. 

Initally EMR was promised as a paperless system and everyone's chart would be on one system.  With all the rules and constraints imposed by insurance companies, we are using more paper now than ever.  Meaningful use.  LOL.. For who? 

Patient's were originally in charge of their health, now insurance companies could mandate that providers get a patients's HgB A1c < 6.0.  It was no longer the patient's job to take responsibility for their own health.  The push for the provider to be responsible for the patient was on. 

I have enjoyed healthcare less and less over the years as EMR has implemented more and more.  I may still use something like Practice fusion for e-prescribing but I am hesitant to implement it fully.

Ventana does have a point about getting everything loaded into the system.  If someone does request a chart, then it's easy enough to send it electronically.  Having said that, if a patient wants to submit a claim to their insurance company will the insurance company make it a big deal if I simply use a template system (i.e. MS Word).  In other words, as the provider, is it my job to put it in the insurance companies format (i.e. EMR), or will they do that on their end with my note?  I imagine patient's will want to submit claims and I am just factoring this into my reasoning.  I don't want to be typing up notes more than once.

Part of this message is also just me needing to vent because medicine is becoming such a corporate endeavor.  I truly feel sorry for new graduates coming out into this mess.  The good news is they won't know any different.

 

 

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  I truly feel sorry for new graduates coming out into this mess.  The good news is they won't know any different.
 


That's me 100%. I work with a seasoned doc who just gives the EMR the middle finger. Not sure how she gets away with it. I always have the threat of litigation casting an ominous shadow over the 14 computer monitors, 2 laptops, 5 keyboards, and small pack of wireless bluetooth mice on my desk.
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Hey Darwin,

Just something to keep in mind and yes the disclaimer: this is not legal advice.  Before EMR's providers would still get sued and the paper formats had slight variation just like today's EMR systems.  I don't see EMR as necessarily a way to protect yourself against litigation.  You can do that with proper paper documentation.  A well written note is a well written note it doesn't matter if its hand written or in a digital font, or what we used to call the American Standard Code for Information Interchange (ASCII), or simply just call text today.  

Someone once told me when I was a student to always do what is right for the patient and you really cannot ever go wrong.  I have stuck to that throughout my career, even against management wishes (sometimes to my detriment), but knock on wood, have not been sued yet.  Do what is right for your patient, and do your best to ignore all the other noise.  If the noise is too great you may need to look elsewhere for a job.  

Remember, in the end the patient is suing you.  If they know you truly do care about them, and you haven't been negligent, that is most of it.  Patients are much less likely to sue someone if they know they have had proper treatment, and that you really care about them.

Also your seasoned doc probably has good reason for giving EMR the finger.  I am actively doing my best to use it as little as possible.  What Joelseff said above has a lot of merit and I suspect Joelseff is an experienced provider.

Best to you! 

 

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Unpopular opinion- I love EMRs

There is no question that paper charting is easier to use for the provider- quick and simple to fill out, especially with templates like T sheets.

However, what I was always frustrated by when I did paper charts was the inability to read someone else's handwriting.  A LARGE part of medicine is the ability to communicate with other providers, whether in your own system or in other systems.  It's rare to encounter a patient who hasn't been touched in some way by the medical system, and many patients have already been evaluated by someone that saw them for the issue that they may be seeing you for.  It's extremely important for me to know what has been done for the patient in front of me already, and even more important is the rationale as to why and why not certain things were done.  It is much easier to read this in an EMR than trying to decipher someone's handwriting, and then contacting them to discuss it if you can't read it.  For me, this avoids repeat testing, avoids unnecessary admissions, unnecessary procedures, unnecessary prescriptions, etc.

I believe we're nearing the end of an approximately 20-year era of transition from purely paper charting to purely EMR.  Doing so has had NUMEROUS trials and errors, some worse than others, but it's gradually improving and moving to a point where multiple systems can see the same thing.

Are EMRs perfect?  Of course not.  I get the arguments that they're built for billing and not for charting and purely medical use.  However, they've gotten better over the years, and you'll never convince me that in order to allow others to read what you're writing that it's better to have paper charts over EMRs.  You can't convince me that it's not helpful to see that an admission to a hospital in other state with the full consults, discharge summaries and rationales available to you to review on a patient who presents in front of you for an issue related to that admission.  I can't rely on what the patient tells me, and I doubt I'm alone in that thinking.

You're not just charting for your own sake- you're charting for others to be able to read what you're doing and why.  I am convinced that once I fully understood that concept that I became a better PA

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True anomaly and Rev Ronin both make excellent points.  There was definitely a time when you needed to translate the handwriting of some providers.  If you couldn't translate, or reach them via phone,  your third step might have been to go to a nurse that worked with that provider that wrote the note and they'd be able to translate.   The issue with this is obvious sometimes it could easily have been misinterpreted. 

I think I like Rev Ronin's idea the most because it is clear in MS word, yet you can do without all the extra EMR nonsense.

Rev, just curious.  How do you backup your notes?  Do you use MS word online (MS onedrive), or an external hard drive?  

Thanks!

 

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